Book excerpt: Neurovascular medicine has emerged as an established, semi-independent subspecialty of neurology and neurosurgery. Decision Making in Neurovascular Disease focuses on the challenging process of determining the best approach for managing patients with intracranial atherosclerosis, carotid artery disease, stroke, aneurysms, arteriovenous malformations, arteriovenous fistulae, cavernous malformations, and hypervascular tumors. Leonardo Rangel-Castilla, Robert Spetzler, esteemed coauthors, and an impressive cadre of experts discuss highly divergent modalities including medical management, open cerebrovascular, endovascular, radiosurgery, and combined/multimodality alternatives. The book is organized into seven sections: Ischemic Stroke and Vascular Insufficiency, Aneurysms – Anterior Circulation, Aneurysms – Posterior Circulation, Aneurysms – Other, Arteriovenous Malformations and Fistula, Cavernous Malformations, and Hypervascular Tumors. Chapters include an introduction, decision-making algorithm, whether to treat, conservative management, anatomical considerations, clinical and imaging evaluation, differential diagnosis, treatment options, images, clinical and radiographic follow-up, and suggested reading. Key highlights: Simple algorithms accompanying 71 chapters supported by the latest, most updated information in the literature More than 300 radiologic images help elucidate disease-specific treatment decision making Step-by-step guidance, clinical pearls, surgical nuances, complication avoidance, and evidence-based outcomes provide in-depth understanding Point/counterpoint expert commentary on each case provides balanced insights on potential implications of specific treatments This essential step-by-step book is a must-have for residents and fellows in neurosurgery, neurology, endovascular, interventional radiology, vascular neurology, and neurocritical care, as well as veteran clinicians in these specialties.